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The Decision To Cancel … (10 March 2020 Notes)

The US is now well in to the mode where state and local leaders are having to take key decisions on COVID-19 with respect to closures. It’s a difficult situation. The dilemma is that the available data indicates this has no more implications for the general population than a bad influenza strain. That’s not to minimize COVID19; the problem is we don’t take influenza as seriously as we probably should. The 2017 H3N2 strain hospitalized 810,000 people and killed about 61,000. The current modeling indicates that COVID19 will hospitalize 378 thousand, and kill about 20,000. Big numbers, but smaller than the flu. However …

… before you get too hopeful, for a vulnerable part of the population, COVID19 is pretty bad. Elderly, those with immune disorders, and so forth suffer higher mortality rates from COVID than influenza. But the biggest issue is that it is going to cause a huge stress on the hospital system, especially acute care and ICU’s across the country. The seasonal flu is more or less spread out over time. COVID is likely to have the cases concentrated in a shorter surge. Lets look at the Savannah GA metro area again as an example. Depending on the effectiveness of mitigation measures in slowing the progress and stretching out the “surge”, we can expect over 500 “excess” hospitalizations starting in about the last week of March and run through the end of April or early May. This in a community that has a bit under 1400 beds (3.4 per thousand, which isn’t bad by US standards). That will swamp the system.

A big source of spread are large groups of people sharing a common environment like, say, a big festival or parade. A huge problem is that a large number of people are exposed within a short period of time, meaning they fall sick at about the same time. It may not change to total numbers too much, but it does change the stress on the health care system to have them all crash at once. Let’s say that around March 17th you hold a series of festivals, starting the weekend before. It’s hugely important to the local economy, so you press on. How does that change the numbers? Modeling this kind of thing is an inexact art (while it is science, it’s pretty fuzzy sometimes), but it can provide some perspective. If we plug in the visitors (the population nearly doubles, bringing all sorts of interesting diseases with them) and increased interactions among locals into our model, we go from 500 “excess” hospitalizations to around 1000, and fatalities jump from 30 or so to between 65 and 75 (just among locals; we don’t care about visitors after they have given us their money and gone home 😛 ).

As I’ve indicated a number of times, my major concern is the economy. The panic can be worse than the pandemic – and will potentially harm more people. While no one will directly die from canceling a major cultural event, thousands will lose income, which causes lots of secondary problems that results in shorter, less happy lives. It’s very hard to put numbers to that harm but it is significant. Now, you could argue this should have been planned for and contingencies put in to place long ago to deal with both the health care system and economic impacts. And you’d be right. But that’s in the past: we have to fight the war we have with the tools we have.

If it seems I’m being inconsistent here, you’re right. What’s best for a society isn’t always best for the individual, and vice versa. You have to strike a balance. What is best for society and the economy is to limit closures, accept the excess mortality, and press on. What is best for vulnerable individuals is to Shut Down Everything. But, that carries a hidden cost in lives as well – disrupted economies kill too, just not as blatantly as a virus. When I’ve taught Emergency Management I always emphasize that no matter what you do, TANSTAAFL (There Ain’t No Such Thing As A Free Lunch). You’re going to hurt, even kill people. So, politicians, there you are. It’s harsh, but: Who are you going to kill, and why? Skip the platitudes and explain your choice …

Note for Savannahians – this isn’t to either criticize or endorse the Mayor and Council, but to point out they are in a no win situation. Lots of communities are facing this choice for all kinds of events, as well as closing schools, etc. I used Savannah as an example because many readers are in that area. These are “bad case” estimates for planning purposes, not by any means the worst case scenarios, but not terribly optimistic either.

As a repeat, here are the practical advice. In short, same as it ever was: Wash your hands, don’t touch your face, don’t freak out. The best source of practical information is at the CDC web site, and the DHS/FEMA “ready.gov” pandemic preparation site. Essentially, these are common sense actions. But here are a couple of things to emphasize: If you or a member of your family is over 65 (and especially over 75), or has health problems (especially respiratory or immune system issues), you should take some extra precautions. Avoid crowds, limit travel where you will be exposed to people, be super-fastidious about hygiene, and so forth, until this thing subsides, hopefully in a few months. If you have family in the hospital or long term care facility (or living on their own for that matter) you may need to hold off visiting for a while. Call often, make sure they are OK, and that they understand why this needs to be. Some other suggestions are to get a good thermometer (the no-touch ones are getting reasonably priced, just make sure it is reliable), and build a “baseline” temperature profile for your family. 98.6F is the accepted average, but that may not be your number. A two degree above normal temperature is considered a fever. My “normal” temperature is around a degree lower than that, so if I’m at 99.6, I’m running a two degree temperature and something’s up.

I wouldn’t call being over 65 a “strike” – it’s less about age per se than the things that go along with age like a weaker immune system. In your case I’d be more concerned about the impact of any drugs you are taking to manage RA depressing your immune system. I’d bounce that question off of your doctor …

Thanks, That’s one of the reasons I’ve never taken drugs for it and as far as the doctor, I haven’t seen one for a couple of years and now doesn’t seem like a good time to be in waiting rooms with sick people.